The Board may sanction financial assistance to the beneficiaries who are [hospitalized in Government Hospitals or in any of the Private Hospitals specified in Schedule I of the Karnataka Government Servants (Medical Attendance) Rules, 1963] for five or more days due to any disease. The financial assistance shall be Rs. 400/- for the first five days and Rs. 50/- each for remaining days, [subject to the maximum Rs. 6000/- (Rupees six thousand only). The application in Form XX along with a medical certificate in Form XXII-A] shall be submitted with such other documents as may be specified by the Board.